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Postural Tremor, Huntington's Disease, Tourette's Syndrome, Wilsons's Disease and Drug Induced Dyskinesia – Medication of Movement Disorders

by Pravin Shukle, MD
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    00:01 We're going to talk now about drugs used to treat other movement disorders or what we call non Parkinsonian movement disorders. We're going to start off first with tremor.

    00:11 Now, you're going to cover tremor in much more detail in your neurology lectures, I'm only going to talk about the medications.

    00:19 Propranolol is a beta blocker. Other beta blockers can be used as well.

    00:24 Propranolol is a very effective agent in postural tremor. It seems to respond well to beta blockade, we're not exactly sure why that happens. Gabapentine, primidone and topiramate are also anti-epileptic drugs that may also work in postural tremor.

    00:43 Huntington's disease is a complex carrier form type of movement. It's inherited. It's passed on.

    00:49 It affects the GABA function. So, by giving medications to affect GABA function, we can reduce Huntington's disease.

    00:59 So, drugs like reserpine and tetrabenazine deplets the levels of amines.

    01:04 We really are not sure how it works entirely, which is why my lectures are a little bit sparse in terms of mechanism of action.

    01:13 We think that it corrects brain neurotransmitter imbalances. We are not sure though.

    01:19 Gabapentin, primidone and topiramate are anti-epileptic drugs that may also work in this disease.

    01:27 Haloperidol, also known as haldol, is a dopamine receptor antagonist, and for some reason it works although we're not really sure what the mechanism is.

    01:39 Tourette's syndrome is a harder one to treat. We look at D2 receptor antagonism.

    01:47 So, haloperidol and pimodize are D2 receptor antagonists and carbamezapine is an anti-seizure medication.

    01:55 It has been described as being less useful but it is something that we can try.

    02:01 And on one of my patients, it has actually worked quite well where haloperidol didn't work at all.

    02:06 Once again, we're not sure how it works. Other agents that we have used are benzodiazepine. They tend to be less useful.

    02:15 And clonidine which is the very first treatment we used in Tourette's syndrome. It's an alpha blocker that works centrally in the brain. It is less useful as well.

    02:26 Wilson's disease. Now, Wilson's disease is generally thought that it was liver disease.

    02:33 The classical finding in Wilson's disease is a Kayser-Fleischer ring that's seen in the eye on eye exams.

    02:41 You can see a little bit of a brown haze on the edges of the iris. This is a disorder of copper metabolism.

    02:49 Why am I talking about it here? Because it does result in neurological damage.

    02:55 Myasthenia can occur. And mild movement disorders that are very nonspecific can occur in Wilson's disease.

    03:02 This is why, just as a clinical pearl, always do a good eye exam in your patients and take a close look at their iris cause you may actually pick up Wilson's disease. I've done it a couple of times in my own patients.

    03:15 The treatment is penicillamine. Now, penicillamine chelates copper out of the blood.

    03:20 So, if you can give them penicillamine early enough, you can actually treat the movement disorder associated with Wilson's disease.

    03:32 Restless leg syndrome is a particular problem we don't really know why it occurs and we think that it might be dopamine related pathways. Pramipexole is probably the most commonly used treatment of restless leg syndrome We also have used carbamezepine or Tegretol for treatment of it.

    03:54 Drug induced dyskinesias, I've mentioned them before in the psychosis lecture, benztropine is the antidote.

    04:02 Acute dystonia is often caused by antipsychotics. We administer benztropine as quickly as possible.

    04:10 Tardive dyskinesia is another type of drug induced dyskinesia. It may be due to a D2 receptor malfunction or damage to the D2 recptor, we're not sure. We know of course that fetal alcohol syndrome may develop tardive dyskinesia just after one dose of the antipsychotic agent. I mentioned this already in the psychosis lecture previously.

    04:35 It's hard to treat. No specific treatment. And once again, we can use clonazepam, clozapine and other drugs.

    04:46 So there you have it. These are the non Parkinsonian movement disorders. I'm sure you'll do very well on your exams.


    About the Lecture

    The lecture Postural Tremor, Huntington's Disease, Tourette's Syndrome, Wilsons's Disease and Drug Induced Dyskinesia – Medication of Movement Disorders by Pravin Shukle, MD is from the course CNS - Pharmacology. It contains the following chapters:

    • Postural Tremor
    • Huntington's Disease
    • Tourette's Syndrome
    • Wilsons's Disease
    • Drug Induced Dyskinesia

    Included Quiz Questions

    1. Huntington's disease with reserpine
    2. Wilson's disease with penicillamine
    3. Postural tremor with propranolol
    4. Tourettes Syndrome with haloperidol
    5. Drug induced dyskinesia with benztropine
    1. She may have Wilson's disease, careful inspection of the iris for Kayser-Fleischer rings.
    2. She may have Parkinson's disease, careful inspection of the fingers for a pill-rolling tremor.
    3. She may have Tourette's syndrome, careful analysis of abnormal movements or speech pattern.
    4. She may have central retinal vein occlusion, careful analysis of the eye for cotton wool spots and hemorrhages (blood and thunder).
    5. She has hypercholesterolemia, careful analysis of the eye for arcus senilis.
    1. Haloperidol
    2. Bromocriptine
    3. Carbidopa
    4. Clozapine
    5. Omeprazole

    Author of lecture Postural Tremor, Huntington's Disease, Tourette's Syndrome, Wilsons's Disease and Drug Induced Dyskinesia – Medication of Movement Disorders

     Pravin Shukle, MD

    Pravin Shukle, MD


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